Annals of Surgical Oncology

, Volume 26, Issue 3, pp 821–826 | Cite as

Breast Reconstruction in an Underserved Population: A Retrospective Study

  • Maxime M. Wang
  • Elizabeth Warnack
  • Kathie-Ann JosephEmail author
Reconstructive Oncology



Breast reconstruction can help restore the shape and appearance of breasts after surgery. Studies have shown that minority and uninsured patients are less likely to receive breast reconstruction after mastectomy.


We sought to determine if post-mastectomy reconstruction varied by patient ethnicity and insurance status in a medically underserved population.


This was a retrospective study of mastectomy patients seen at Bellevue Hospital Center, a safety-net hospital in New York City, between January 2010 and December 2015. The Chi square test was used to compare patient characteristics versus type of reconstruction chosen and likelihood of reconstruction. Logistic regression was used to examine likelihood of reconstruction, controlling for patient insurance status, race, age, stage at presentation, and contralateral prophylactic mastectomy.


Of the 750 patients included in the database, 220 underwent mastectomy. Overall, 73.6% of our patient population received breast reconstruction. Patients with Medicare insurance were less likely to get reconstruction compared with patients with other types of insurance (37.5%, p = 0.04). Hispanic patients were most likely to receive reconstruction (89.1%), followed by Black patients (80%) and Asian patients (66.7%) [p = 0.03]. There were no significant associations between patient race or stage at presentation and type of reconstruction. In a multivariate logistic regression, advancing age was associated with a decreased likelihood of reconstruction (adjusted odds ratio 0.91, p < 0.001).


In our underserved patient population, patients received breast reconstruction at rates higher than the national average. Institutional availability of patient navigators and preoperative counseling may contribute to more equal access to breast reconstruction.



Maxime M. Wang, Elizabeth Warnack, and Kathie-Ann Joseph have no financial interests to disclose.


  1. 1.
    Smedley BD, Stith AY, Nelson AR. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: Institute of Medicine; 2002.Google Scholar
  2. 2.
    Fiscella K, Franks P, Gold M, Clancy C. Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care. JAMA. 2000;283(19):2579–2584.CrossRefGoogle Scholar
  3. 3.
    Potosky AL, Breen N, Graubard BI, Parsons PE. The association between health care coverage and the use of cancer screening tests. Med Care. 1998;36(3):257–270.CrossRefGoogle Scholar
  4. 4.
    Gornick ME, Eggers PW, Reilly TW, Mentnech RM, Fitterman LK, Kucken LE, et al. Effects of race and income on mortality and use of services among Medicare beneficiaries. N Engl J Med. 1996;335(11):791–799.CrossRefGoogle Scholar
  5. 5.
    Maloney NK, Erb D, Schneider H, Goffman T, Elkins D, Laronga C. Impact of race on breast cancer in lower socioeconomic status women. Breast J. 2006;12(1):58–62.CrossRefGoogle Scholar
  6. 6.
    Wu XC, et al. Influence of race, insurance, socioeconomic status, and hospital type on receipt of guideline-concordant adjuvant systemic therapy for locoregional breast cancers. J Clin Oncol. 2012;30(2):142–50.CrossRefGoogle Scholar
  7. 7.
    Yedjou CG, Tchounwou PB, Payton M, et al. Assessing the racial and ethnic disparities in breast cancer mortality in the United States. Int J Environ Res Public Health 2017;14(5):pii: E486.Google Scholar
  8. 8.
    Bauder A, Gross C, Killelea B, Butler P, Kovach S, Fox J. The relationship between geographic access to plastic surgeons and breast reconstruction rates among women undergoing mastectomy for cancer. Ann Plast Surg. 2017;78(3):324–329.CrossRefGoogle Scholar
  9. 9.
    Lee C, Deal A, Huh R, et al. Quality of patient decisions about breast reconstruction after mastectomy. JAMA Surg. 2017;152(8):741.CrossRefGoogle Scholar
  10. 10.
    Winton L, Nodora J, Martinez M, et al. Factors associated with surgical management in an underinsured, safety net population. Surgery. 2016;159(2):580–590.CrossRefGoogle Scholar
  11. 11.
    Shippee T, Kozhimannil K, Rowan K, Virnig B. Health insurance coverage and racial disparities in breast reconstruction after mastectomy. Women’s Health Issues. 2014;24(3):e261–e269.CrossRefGoogle Scholar
  12. 12.
    Alderman A, Hawley S, Janz N et al. Racial and ethnic disparities in the use of postmastectomy breast reconstruction: results from a population-based study. J Clin Oncol. 2009;27(32):5325–5330.CrossRefGoogle Scholar
  13. 13.
    Soni S, Lee M, Gwede C. Disparities in use and access to postmastectomy breast reconstruction among African American women. Cancer Control. 2017;24(4):107327481772905.CrossRefGoogle Scholar
  14. 14.
    Rodby KA, Danielson KK, Shay E, Robinson E, Benjamin M, Antony AK. Trends in breast reconstruction by ethnicity: an institutional review centered on the treatment of an urban population. Am Surg. 2016;82(2):497–504.Google Scholar
  15. 15.
    Offodile A, Tsai T, Wenger J, Guo L. Racial disparities in the type of postmastectomy reconstruction chosen. J Surg Res. 2015;195(1):368–376.CrossRefGoogle Scholar
  16. 16.
    Pressman M, Bohlen S. 2013 Community Health Needs Assessment and Implementation Strategy. Available at: Accessed 16 Jan 2018.
  17. 17.
    Cancer Center Clinics—Patients and Visits, Bellevue Hospital. 2017:1–3.Google Scholar
  18. 18.
    Eisert SL, Mehler PS, Gabow PA. Can America’s urban safety net systems be a solution to unequal treatment? J Urban Health. 2008;85(5):766–778.CrossRefGoogle Scholar
  19. 19.
    NYC Health+Hospitals. Cancer Center. 2018. Available at: Accessed 10 Sep 2018.
  20. 20.
    NYU Langone Health, Perlmutter Cancer Center. Beatrice W. Welters Breast Health Outreach & Navigation Program. 2018. Available at: Accessed 10 Sep 2018.
  21. 21.
    Freeman H. A Model patient navigation program. Oncol Issues. 2004;19(5):44–46.CrossRefGoogle Scholar
  22. 22.
    Battaglia T, Darnell J, Ko N et al. The impact of patient navigation on the delivery of diagnostic breast cancer care in the National Patient Navigation Research Program: a prospective meta-analysis. Breast Cancer Res Treat. 2016;158(3):523–534.CrossRefGoogle Scholar
  23. 23.
    Please check and confirm that the list of authors are correct.Cole H, Thompson H, White M, et al. Community-based, preclinical patient navigation for colorectal cancer screening among older black men recruited from barbershops: the MISTER B trial. Am J Public Health. 2017;107(9):1433–1440.CrossRefGoogle Scholar
  24. 24.
    Jean-Pierre P, Cheng Y, Wells K, et al. Satisfaction with cancer care among underserved racial-ethnic minorities and lower-income patients receiving patient navigation. Cancer. 2016;122(7):1060–1067.CrossRefGoogle Scholar
  25. 25.
    Molina Y, Silva A, Rauscher GH. Racial/ethnic disparities in time to a breast cancer diagnosis: the mediating effects of healthcare facility factors. Med Care. 2015;5(10): 872–878.CrossRefGoogle Scholar
  26. 26.
    Akinyemiju T, Naik G, Ogunsina K, Dibaba D, Vin-Raviv N. Demographic, presentation, and treatment factors and racial disparities in ovarian cancer hospitalization outcomes. Cancer Causes Control. 2018;29(3):333–342.CrossRefGoogle Scholar
  27. 27.
    Jones L, Ferrans C, Polite B, et al. Examining racial disparities in colon cancer clinical delay in the Colon Cancer Patterns of Care in Chicago study. Ann Epidemiol. 2017;27(11):731–738.e1.CrossRefGoogle Scholar
  28. 28.
    Mokdad A, Murphy C, Pruitt S, et al. Effect of hospital safety net designation on treatment use and survival in hepatocellular carcinoma. Cancer. 2017;124(4):743–751.CrossRefGoogle Scholar
  29. 29.
    Voineskos SH, Frank SG, Cordeiro PG. Breast reconstruction following conservative mastectomies: predictors of complications and outcomes. Gland Surg. 2015;4(6):484–496.Google Scholar

Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Maxime M. Wang
    • 1
  • Elizabeth Warnack
    • 1
  • Kathie-Ann Joseph
    • 1
    Email author
  1. 1.Department of SurgeryNew York University School of MedicineNew YorkUSA

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